Traumatic Spondylopelvic Dissociation: A Report of Two Cases of Spondylolisthesis at L5-S1 and Review of Literature.

Study Design Retrospective chart review and review of literature. Objective Few case reports of traumatic L5-S1 displacement have been presented in the literature. Here we present two cases of traumatic spondylolisthesis showing both anterior and posterior displacement, the treatment algorithm, and a review of the literature. Methods The authors conducted a retrospective review of representative patients and a literature review of traumatic spondylolisthesis at the L5-S1 junction. Two representative patients were identified with traumatic spondylolisthesis: one with an anterior dissociation, and the other with a posterior dissociation. Results Radiographic, computed tomography, and magnetic resonance imaging illustrated the bony and soft tissue injury found in each patient, as well as the final stabilization and outcomes. Operative stabilization was necessary, and both patients were treated with open reduction internal fixation. The patient with posterior dissociation had complete recovery without neurologic sequelae. The patient with anterior dissociation had persistent bilateral L5-S1 radiculopathy with intact rectal tone, due to neurologic compression. Conclusions Few cases of traumatic spondylopelvic dissociation that are isolated to the L5-S1 disk space are described in the literature. We examined both an anterior and a posterior dissociation and treated both with L5-S1 posterior spinal fusion. The patient with anterior dissociation had persistent L5-S1 root injury; however, the patient with posterior dissociation had no neurologic deficits. This is the opposite of what is expected based on anatomy. These cases offer insight into the management of anterior and posterior L5-S1 spondylopelvic dissociation

Pre-ART Care in Ethopia: A Qualitative Look at Practice and Guideline Implications for Top Down and Bottom Up Implementation

Background: Pre-ART, defined as all services provided between the timeframe of a patient testing positive to HIV till the first dose of antiretroviral, can be a crucial period in patient retention and attrition. Therefore, this study aims to examine practices around facility level Pre-ART throughout Ethiopia based on discussions with clinicians and facility staff and to determine potential considerations for country specific Pre-ART guidelines and future public health practice in other resource constrained countries. Methods: Framework Analysis was applied to secondary data derived from key informant interviews with facility level clinicians and staff in Ethiopia regarding themes around Pre-ART. We identified significant data surrounding the practices and processes currently taking place at a sample of six sites. An exploratory understanding of the challenges and best practices surrounding Pre-ART was highlighted and themes to be taken under consideration by a Pre-ART guideline-working group in Ethiopia were noted. Results: Study sites indicated various service provisions and practices around Pre-ART care along the testing to treatment cascade. Patient tracking, Cotrimoxazole prescription, access to CD4 machines, and data management practices varied by facility. Similar practices around linkages from testing to treatment were noted across facilities. Conclusion: Combining the local resource reservoir with a national guideline plan allow for the ideal meshing of top down and bottom up implementation and will minimize the pitfalls of system wide rollout of Pre-ART guidelines. The ultimate goals behind any Pre-ART program should be to provide a measure of care and support which patient’s value. The benefits then derived from this valuation result in the key public health outcomes, namely in terms of patient retention, early initiation onto ART, and continued monitoring of patient progress across the testing to treatment cascade. Meeting these goals and objectives hinges on a collaborative effort and one that bridges the divide of policy makers and practitioners

Tattoos and Piercings: A Review for the Emergency Physician

Tattoos and piercings are increasingly part of everyday life for large sections of the population, and more emergency physicians are seeing these body modifications (BM) adorn their patients. In this review we elucidate the most common forms of these BMs, we describe how they may affect both the physical and psychological health of the patient undergoing treatment, and also try to educate around any potential pitfalls in treating associated complications

Implicaciones socioculturales del turismo y balance de la Antropología del turismo sobre Andalucía

Knee replacement is a common preference sensitive quality-of-life procedure that can reduce pain and improve function for people with advanced knee arthritis. While most patients improve, knee replacement surgery has the potential for serious complications. Prosthetic knee infection is an uncommon but serious complication. This study explored the impact of cases of prosthetic knee infection on surgeons' personal and professional wellbeing. Qualitative telephone interviews were conducted with consultant orthopaedic surgeons who treated patients for prosthetic knee infection in one of six high-volume NHS orthopaedic departments. Data was audio-recorded, transcribed and analysed thematically. Eleven surgeons took part. Analysis identified three overarching themes: (i) At some point infection is inevitable but surgeons still feel accountable; (ii) A profound emotional impact and (iii) Supporting each other. The occurrence of prosthetic joint infection has a significant emotional impact on surgeons who report a collective sense of devastation and personal ownership, even though prosthetic joint infection cannot be fully controlled for. Surgeons stressed the importance of openly discussing the management of prosthetic joint infection with a supportive multidisciplinary team and this has implications for the ways in which orthopaedic surgeons may be best supported to manage this complication. This article also acknowledges that surgeons are not alone in experiencing personal impact when patients have infection

Spying and Surveillance in Shakespeare’s Dramatic Courts

This thesis examines representations of spying and surveillance in Shakespearean drama in conjunction with historical practices of espionage in later sixteenth-century England. The introductory chapter outlines how spying operations were conducted in Elizabethan England, with specific attention to the complex attitudes and behaviour of individual agents working in the broader context of the religious wars, both hot and cold, taking place between Protestant England and the Catholic powers of continental Europe. It also provides some analysis of the organisational structures within which those agents worked and examines a wide range of particular cases to illustrate how surveillance operations might play out in practice. The memory of Sir Francis Walsingham, often described as the ‘spymaster’ of Elizabeth’s government and noted for his skill in intelligence work, would have loomed large for any dramatist thinking about espionage at the turn of the seventeenth century. Subsequent chapters each examine a specific play in light of the material presented in the introduction, comprising Much Ado About Nothing, The Tempest, Measure for Measure, Henry V and Hamlet. Each chapter seeks to elucidate how Shakespeare draws upon the world of Elizabethan espionage to provide vital structural components in his dramatic plotting, especially as regards inter-personal relationships between courtiers, secretaries and agents on the ground. Real individuals and the spies depicted in Shakespeare’s plays all behave in a manner that is personally inflected to a profound degree, and it is this particular aspect of early-modern espionage that provides the single most important connection between history and drama. Periodically, this thesis also reflects upon the metatheatrical relationship between characters’ schemes and Shakespeare’s own plotting as a dramatist

Optical tweezers toolbox: better, faster, cheaper; choose all three

Numerical computation of optical tweezers is one path to understanding the subtleties of their underlying mechanism—electromagnetic scattering. Electromagnetic scattering models of optical trapping can be used to find the properties of the optical forces and torques acting on trapped particles. These kinds of calculations can assist in predicting the outcomes of particular trapping configurations. Experimentally, looking at the parameter space is time consuming and in most cases unfruitful. Theoretically, the same limitations exist but are easier to troubleshoot and manage. Towards this end a new more usable optical tweezers toolbox has been written. Understanding of the underlying theory has been improved, as well as the regimes of applicability of the methods available to the toolbox. Here we discus the physical principles and carry out numerical comparisons of performance of the old toolbox with the new one and the reduced (but portable) code

Anatomy ontologies and potential users: bridging the gap.

MOTIVATION: To evaluate how well current anatomical ontologies fit the way real-world users apply anatomy terms in their data annotations. METHODS: Annotations from three diverse multi-species public-domain datasets provided a set of use cases for matching anatomical terms in two major anatomical ontologies (the Foundational Model of Anatomy and Uberon), using two lexical-matching applications (Zooma and Ontology Mapper). RESULTS: Approximately 1500 terms were identified; Uberon/Zooma mappings provided 286 matches, compared to the control and Ontology Mapper returned 319 matches. For the Foundational Model of Anatomy, Zooma returned 312 matches, and Ontology Mapper returned 397. CONCLUSIONS: Our results indicate that for our datasets the anatomical entities or concepts are embedded in user-generated complex terms, and while lexical mapping works, anatomy ontologies do not provide the majority of terms users supply when annotating data. Provision of searchable cross-products for compositional terms is a key requirement for using ontologies.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

The failure of suicide prevention in primary care: family and GP perspectives - a qualitative study

Background Although Primary care is crucial for suicide prevention, clinicians tend to report completed suicides in their care as non-preventable. We aimed to examine systemic inadequacies in suicide prevention from the perspectives of bereaved family members and GPs.Methods Qualitative study of 72 relatives or close friends bereaved by suicide and 19 General Practitioners who have experienced the suicide of patients.Results Relatives highlight failures in detecting symptoms and behavioral changes and the inability of GPs to understand the needs of patients and their social contexts. A perceived overreliance on anti-depressant treatment is a major source of criticism by family members. GPs tend to lack confidence in the recognition and management of suicidal patients, and report structural inadequacies in service provision.Conclusions Mental health and primary care services must find innovative and ethical ways to involve families in the decision-making process for patients at risk of suicide